Everyday people can experience PTSD nightmare

Published 10:49 am, Friday, September 13, 2013

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Karin Thompson, PhD, is director of the Post Traumatic Stress Disorder Clinic Program at the Michael E. DeBakey VA Medical Center in Houston. The VA has had programs to treat veterans suffering from PTSD since 1988, a disorder recognized in the early 1980s. But PTSD is not confined to the battlefield.

"In the general population, PTSD occurs in about 15 to 20 percent of people exposed to a traumatic experience," Thompson said. "Most people who go through a traumatic experience recover on their own although it might take some time for them to regain their footing."

A traumatic experience based on research is defined as, "exposure to actual or threatened death, serious injury or sexual violence" and this can happen by directly experiencing it or by witnessing it in person.

"An experience also could be defined as 'traumatic' if you learn one of these experiences (threatened death, serious injury or sexual violence) happened to a close friend or family member," Thompson said. "In the case of a death of a family member, to be considered traumatic, the death must be violent or accidental."

Those subjected to repeated exposure to details of these experiences, i.e., first responders, police officers, funeral directors, fire fighters or soldiers in combat (the criteria is if this repeated exposure is part of their job) may experience symptoms of PTSD.

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Thompson said it is not uncommon to see people who function normally in their day-to-day work to have PTSD related to earlier combat experiences triggered later in life when they retire, are injured or lose their spouse.

"That's one way PTSD can work. Through natural recovery after a traumatic experience, they do fine, but later in life, they experience something traumatic or stressful that can bring up past experiences. War memories begin bothering them. They have nightmares and begin feeling distressed during the day. This is delayed onset," she said.

"Sometimes people have symptoms of PTSD immediately after the experience of war, an accident, a life-threatening experience or sexual violence," Thompson said. "In other cases, symptoms are delayed until a later trauma triggers them. This is very distressing to the patient because not only are they dealing with what happened recently, i.e., death of spouse, retirement or injury from an accident, but they are dealing with something that happened long ago."

In male and female patients alike, having PTSD makes them lose self-esteem and feel badly about themselves, i.e., not being strong enough, or symptoms as a sign of weakness. Having these memories bothers patients enough to cause them to question themselves.

Thompson said PTSD is not limited to military. Anyone can have PTSD - from being involved in an auto accident, being assaulted, losing a partner or a child or surviving a natural disaster, such as a hurricane or flood.

"People can go through those experiences and recover on their own," she said. "They also can develop depression and/or some of the symptoms of PTSD such as reliving or re-experiencing a traumatic event that is intrusive or upsetting to their daily activities."

Symptom

A sign of PTSD is when someone will have their memory of a traumatic event come back. They will dream about it, think about it, see something similar on TV or something in the environment that triggers the memory.

"To have PTSD, there's more than just these symptoms and feelings, but these are the distinguishing features," Thompson said.

"Some people become very depressed," she said, "or re-experiencing that memory begins to interfere with work and relationships. When these symptoms are obvious, it's good to talk to their primary caregiver as a starting point, just to get some insight."

At the MEDVAMC, the focus of treatment for PTSD is on providing evidence-based treatment, the best treatments based on research.

"Psychotherapy is very effective, and there are two types of cognitive behavior therapies - (1) prolonged exposure and (2) cognitive processing," Thompson said. "We also provide anxiety management as well as depression and substance abuse counseling, and generally, our patients begin feeling better within 10-12 weeks. We see really good results."

In this program, the patient meets once week with therapist and talks about experience over and over again. The "exposure" of this method is exposure to the memory, rather than avoiding. Avoidance prolongs the disorder. If they confront memory, they can begin healing.

In cognitive processing, the patient participates in group or individual therapy.

"The goal is to help the patient process and take into account their total experience," Thompson said.

"In this therapy, we help patient look at the meaning of the event, and what they're telling themselves about the experience. We encourage them to take into account the full picture and to change beliefs, such as 'the world is a dangerous place,' or 'some people can't be trusted.' "

She said some patients may have PTSD, but are suffering from severe depression and/or substance abuse, and these should be treated first.

"PTSD is a very individual disorder," Thompson said. "Everyone's different. There are patterns, such as re-experiencing and/or avoidance, where the patient makes a lot of effort to avoid reminders, i.e., avoiding things they used to do. They might avoid relationships because triggering is so uncomfortable."

"We also see a high level of alertness (trouble sleeping) or hyper-reactivity (inability to tolerate sudden loud noises)," she said. "This doesn't mean the person has PTSD or they may not have full disorder."

Once PTSD is treated, it's treated. "If the patient experiences another trauma, they may experience some of the symptoms, and we encourage them to return when this happens," she said.

"The current wars have helped raise public awareness of PTSD, and we are now seeing people at the VA for the first time from earlier wars as well as those who are recently returned from battle," Thompson said. "But the reality is any of us can get PTSD."

A recent movement in the VA is to make mental health screening part of the physical health check-up. "People suffering from PTSD really feel alone, but options do exist," Thompson said. "The difficulty is getting people to seek treatment.